Organization
NORTH SUBURBAN ORAL AND MAXILLOFACIAL SURGERY LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RICHARD P. MARTINO DDS (PRESIDENT)
(847) 234-3390
Entity
Organization
Contact information
Practice address
900 N WESTMORELAND RD, SUITE 208, LAKE FOREST, IL 60045-1674
(847) 234-3390
(847) 234-3391
Mailing address
900 N WESTMORELAND RD, SUITE 208, LAKE FOREST, IL 60045-1674
(847) 234-3390
(847) 234-3391
Taxonomy
Speciality
Code
Description
License number
State
1223P0106X
Oral and Maxillofacial Pathology Dentistry
Primary
021000537
IL
Other
Enumeration date
08/31/2006
Last updated
02/10/2009
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